Obstructed labour

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Obstructed labour
Synonyms Labour dystocia
Illustration of a deformed female pelvis - angular distortion Wellcome L0038229.jpg
An image of a deformed pelvis, a risk factor for obstructed labour
Specialty Obstetrics
Complications Perinatal asphyxia, uterine rupture, post-partum bleeding, postpartum infection[1]
Causes Large or abnormally positioned baby, small pelvis, problems with the birth canal[2]
Risk factors Shoulder dystocia, malnutrition, vitamin D deficiency[3][2]
Diagnostic method Active phase of labour > 12 hours[2]
Treatment Cesarean section, vacuum extraction with possible surgical opening of the symphysis pubis[4]
Frequency 6.5 million (2015)[5]
Deaths 23,100 (2015)[6]

Obstructed labour, also known as labour dystocia, is when, even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked.[2] Complications for the baby include not getting enough oxygen which may result in death.[1] It increases the risk of the mother getting an infection, having uterine rupture, or having post-partum bleeding.[1] Long term complications for the mother include obstetrical fistula.[2] Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than twelve hours.[2]

The main causes of obstructed labour include: a large or abnormally positioned baby, a small pelvis, and problems with the birth canal.[2] Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone.[2] Risk factors for a small pelvis include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency.[3] It is also more common in adolescence as the pelvis may not have finished growing.[1] Problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors.[2] A partograph is often used to track labour progression and diagnose problems.[1] This combined with physical examination may identify obstructed labour.[7]

The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis.[4] Other measures include: keeping the women hydrated and antibiotics if the membranes have been ruptured for more than 18 hours.[4] In Africa and Asia obstructed labor affects between two and five percent of deliveries.[8] In 2015 about 6.5 million cases of obstructed labour or uterine rupture occurred.[5] This resulted in 23,000 maternal deaths down from 29,000 deaths in 1990 (about 8% of all deaths related to pregnancy).[2][6][9] It is also one of the leading causes of stillbirth.[10] Most deaths due to this condition occur in the developing world.[1]

Cause[edit]

The main causes of obstructed labour include: a large or abnormally positioned baby, a small pelvis, and problems with the birth canal.[2] Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone.[2] Risk factors for a small pelvis include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency.[3] while problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors.[2]

Diagnosis[edit]

Obstructed labour may be diagnosed based on physical examination.[7]

Treatment[edit]

The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis.[4] Other measures include: keeping the women hydrated and antibiotics if the membranes have been ruptured for more than 18 hours.[4]

Prognosis[edit]

If cesarean section is obtained in a timely manner, prognosis is good.[1] Prolonged obstructed labour can lead to stillbirth, obstetric fistula, and maternal death.[11]

Epidemiology[edit]

In 2013 it resulted in 19,000 maternal deaths down from 29,000 deaths in 1990.[9]

Etymology[edit]

The word dystocia means difficult labour.[1] Its antonym is eutocia (Ancient Greek: τόκος, translit. tókos, lit. 'childbirth') or easy labour.

Other terms for obstructed labour include: difficult labour, abnormal labour, difficult childbirth, abnormal childbirth, and dysfunctional labour.

Other animals[edit]

The term can also be used in the context of various animals. Dystocia pertaining to birds and reptiles is also called egg binding.

In part due to extensive selective breeding, miniature horse mares experience dystocias more frequently than other breeds.

References[edit]

  1. ^ a b c d e f g h Neilson, JP; Lavender, T; Quenby, S; Wray, S (2003). "Obstructed labour". British medical bulletin. 67: 191–204. doi:10.1093/bmb/ldg018. PMID 14711764. 
  2. ^ a b c d e f g h i j k l m Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organisation. 2008. pp. 17–36. ISBN 9789241546669. Archived (PDF) from the original on 2015-02-21. 
  3. ^ a b c Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organisation. 2008. pp. 38–44. ISBN 9789241546669. Archived (PDF) from the original on 2015-02-21. 
  4. ^ a b c d e Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organisation. 2008. pp. 89–104. ISBN 9789241546669. Archived (PDF) from the original on 2015-02-21. 
  5. ^ a b GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577Freely accessible. PMID 27733282. 
  6. ^ a b GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903Freely accessible. PMID 27733281. 
  7. ^ a b Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organisation. 2008. pp. 45–52. ISBN 9789241546669. Archived (PDF) from the original on 2015-02-21. 
  8. ^ Usha, Krishna (2004). Pregnancy at risk : current concepts. New Delhi: Jaypee Bros. p. 451. ISBN 9788171798261. Archived from the original on 2016-03-04. 
  9. ^ a b GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385: 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604Freely accessible. PMID 25530442. |Supplementary Appendix Page 190 
  10. ^ Goldenberg, RL; McClure, EM; Bhutta, ZA; Belizán, JM; Reddy, UM; Rubens, CE; Mabeya, H; Flenady, V; Darmstadt, GL; Lancet's Stillbirths Series steering, committee. (21 May 2011). "Stillbirths: the vision for 2020". Lancet. 377 (9779): 1798–805. doi:10.1016/S0140-6736(10)62235-0. PMID 21496912. 
  11. ^ Carmen Dolea, Carla AbouZahr (July 2003). "Global burden of obstructed labour in the year 2000" (PDF). Evidence and Information for Policy (EIP), World Health Organization. 

Further reading[edit]

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External resources